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Increased rates of symptomatic nonunion
3%
155/5103
Similar rates of symptomatic nonunion
8%
410/5103
No differences in cosmetic results
2%
120/5103
Increased functional outcome scores
79%
4045/5103
Improved range of motion of the shoulder
7%
344/5103
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Surgical fixation of this significantly displaced clavicle fracture (greater than 100%) has been associated with greater functional outcomes up to 1 year after injury compared to non-operative measures Clavicle fractures are often seen in young active patients as the result of falls or direct compressive trauma. Non-operative management of midshaft clavicle fractures is associated with decreased shoulder strength and increased nonunion rates. Risk factors for non-union in non-operative management of midshaft clavicle fractures include advanced age, female gender, displacement and comminution. Open reduction and internal fixation of clavicle fractures is associated with improved results when there is > 2 cm of shortening and 100% displacement. Zlowodzki et al. retrospectively to compared nonoperative versus operative management of 2144 clavicle fractures. They found that non-operative treatment of displaced midshaft clavicle fractures had a nonunion rate of 15%. Risk of nonunion was reduced by 86% when plating was compared to non-operative measures. The Canadian Orthopaedic Trauma Society conducted a multicenter prospective study comparing non-operative management versus plate fixation of midshaft clavicle fractures. They found that Constant/DASH scores were significantly improved in the operatively treated group at all time points up to one year of followup. Additionally, a lower rate of nonunion/malunion was identified in the operative group. Figure A shows an AP radiograph of the clavicle that is significantly shortened and displaced. Illustration A shows a postoperative AP radiograph of the clavicle after open reduction/internal fixation was completed. Incorrect Answers Answers 1,2: ORIF is associated with decreased rates of nonunion Answer 3: ORIF is associated with improved cosmetic results compared to non operative measures Answer 5: Range of motion after ORIF is comparable to that of non operative treatment
3.8
(16)
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